Cardiovascular Outcomes and Mortality Associated With Discontinuing Statins in Older Patients Receiving Polypharmacy

Abstract

Key Points Question What are the clinical implications of statin discontinuation in older patients receiving polypharmacy? Findings In this population-based cohort study of 29 047 patients, there was evidence that discontinuing therapy with statins was associated with a significantly increased risk of hospital admission for heart failure and any cardiovascular outcome, death from any cause, and emergency admission for any cause. Meaning The findings of this study suggest that discontinuing statins while maintaining other drug therapies may increase the long-term risk of fatal and nonfatal cardiovascular outcomes.

Statin Discontinuation and Cardiovascular Events Among Older People in Denmark

“…Statin discontinuation occurs frequently in practice, 1 and thus evidence to inform shared decision-making on this topic may be useful to clinicians. Our findings of a higher rate of cardiovascular events among those discontinuing statins, along with the findings of previous studies, 19 , 22 highlight the importance of RCTs on this topic. To our knowledge, there is currently only 1 RCT 23 that has investigated the effects of statin discontinuation for primary prevention among persons aged 75 years or older.…”

“…Existing studies have been conducted among persons with mean ages in the 60s or 70s 19 , 20 , 21 and in specific contexts, particularly in palliative care 20 and for exclusively or predominantly primary prevention. 19 , 21 , 22 Given the lack of randomized clinical trials (RCTs) on statin discontinuation, real-world observational data can provide important evidence to support clinical decision-making. 23 The aim of our study was to examine the association of statin discontinuation with the rate of major adverse cardiovascular events (MACE) among individuals aged 75 years or older who were prescribed long-term statins for primary and secondary prevention.…”

Stroke in Older Adults Living in Care Homes: Results From a National Data Linkage Study in Wales

“…19 However, in a recent large observational study of older adults with polypharmacy, deprescribing statins was associated with an increased risk of fatal and non-fatal cardiovascular outcomes. 20 Discontinuation of statin therapy between 3 and 6 months after stroke has been associated with higher risk of recurrent stroke within 1 year, 21 but the evidence for the long-term use of statins for secondary stroke prevention in older people living in care homes who often have frailty, multimorbidity and polypharmacy is unclear.…”

Factors Associated with Discontinuation of Statin Therapy in Patients with Lymphoma Aged 80 Years and Older: A Retrospective Single-Institute Study

“…However, subjective data such as non-hematological toxicity may have been underestimated because this information was dependent on medical records written by physicians before the study was planned. To maximize patient safety, we excluded patients with diabetes mellitus (DM) because randomized controlled trials have shown that statin treatment is beneficial in patients with DM [ 24 ]. To minimize bias due to disease progression, we included only patients who had achieved complete remission of their lymphomas after initial chemotherapy at a single institution and who had remained in continuous complete remission for at least 1 year after chemotherapy.…”